The Wall Street Journal today published a report that home health companies  Amedisys Inc. and Almost Family Inc. are now under investigation by the SEC following a month and a half of Congressional inquiries. You can read the full article here. Although not typically on this scale, these types of investigations and inquiries into billing [...]

Following is a brief summary of this recent court decision that was written by two of our colleagues, Jim Riley and Julie Ann Sullivan: On March 24, 2010, as a result of a whistleblower lawsuit filed in 2005, a federal district court judge in the Middle District of Tennessee found that Renal Care Group (RCG), [...]

On March 29, the jury reached its long-awaited verdict in the case of U.S. ex. rel. Drakeford v. Tuomey Healthcare System. The jury decided that Tuomey did violate the Stark Law, but did not violate the False Claims Act. Now Judge Matthew Perry, Sr. must decide the damages no earlier than April 15. Although the [...]

On December 30, 2009 a U.S. district court in Illinois declined to grant summary judgment to Saint Francis Medical Center (the “Hospital”) in an antitrust suit initiated by Peoria Day Surgery Center (the “ASC”) (Peoria Day Surgery Center v. OSF Healthcare System d/b/a Saint Francis Medical Center, C.D. Ill., No. 06-1236, 12/30/09).  The ruling means [...]

Four of our colleagues at McGuireWoods — Alilson Mikula, Brent Rawlings, Elissa Moore and Tom Stallings — have collaborated on the following short update about the first lawsuit challenging a RAC re-opening of claims filed by a hospital. Please click below to view the update. document.getElementById(“post-713-blankimage”).onload();

On February 27, an Arkansas Court issued a permanent injunction against Baptist Health, prohibiting its economic credentialing policy. This case represents the most recent episode in two distinct, long-running battles currently being waged in the healthcare provider space:  (1) the struggle between hospitals and physicians over credentialing standards (specifically economic factors) and (2) the conflict [...]

The March 10, 2009 issue of the North Carolina Healthcare Report is now available. Please click here to download. document.getElementById(“post-539-blankimage”).onload();

The February 27, 2009 issue of the North Carolina Healthcare Report is now available. Please click here to download. document.getElementById(“post-479-blankimage”).onload();

On February 6, 2008, the Centers for Medicare and Medicaid Services (CMS) announced that the bid protests to the recovery audit contractor program (RAC) program had been settled and the RAC implementation could proceed. The RAC program, authorized by Congress in the Medicare Modernization Act of 2003 and made permanent in the Tax Relief and [...]

  On January 30, 2009 the United States Court of Appeals for the District of Columbia overturned a district court decision and held that Medicare claims are exempt from disclosure under the Freedom of Information Act (“FOIA”).[1]  Consumers’ Checkbook, Center for the Study of Services (“CSS”) had sought disclosure of Medicare claims by physicians in [...]

On January 12, the Ninth Circuit Court of Appeals affirmed a California physician’s 180-month prison sentence for defrauding the Federal Medicare and California State Medi-Cal programs.  The physician, Aziz F. Awad, was found guilty of illegally billing Medicare and Medi-Cal for certain respiratory services that were in many cases not medically necessary, not properly coded, [...]

A federal appeals court recently reversed and remanded a district court decision dismissing a False Claims Act qui tam claim after finding that an arrangement by and between a hospital and anesthesia group violated the Stark Act and the Anti-Kickback Statute (2009 WL 129888, Jan. 29, 2009)..   In the Third Circuit decision, Dr. Kosenske [...]

  In May 2007, Carolinas HealthCare System, the largest health-care system in the Carolinas, and Stanly Regional Medical Center, headquartered in Albemarle, NC, entered into a strategic alliance to offer new and expanded services to North Carolina.  In August 2008, Carolinas HealthCare and Stanly Regional proposed to build a 40-bed rehabilitation hospital in Concord, NC.  [...]

Recent Developments & Trends in Health Care-Related Litigation Complimentary Webinar Thursday, January 29, 2009 Noon – 12:45 p.m. (CT) Online Registration Please join us for a brief webinar discussing recent developments in health care-related litigation, with a special emphasis on antitrust, government investigations and payor/provider relations. Presenters: Jeffrey C. Clark, Partner Richard T. Greenberg, Partner [...]

A federal judge has recently given the go-ahead for a very high profile lawsuit in South Carolina which threatens a hospital with a False Claims Act suit brought by a physician on behalf of the United States government and now a federal investigation.  The Hospital in question is Tuomey Regional Medical Center in Sumter, South [...]

The United States Department of Justice recently agreed to a $5.3 million settlement agreement with New Jersey hospital system Cathedral Healthcare System Inc., which is based in Newark.  The settlement is being made to resolve allegations that the hospital defrauded the Medicare program in connection with improperly inflating charges for inpatient and outpatient care to [...]

On February 23rd, Haywood Regional Medical Center in Clyde, NC, which is just west of Asheville, lost its Medicare certification.  Medicare and Medicaid funding accounted for about 68% of the Hospital’s revenue and as a result, this is obviously a move which jeopardizes the financial health of the Hospital.  In the wake of loss of [...]

  If you would like a copy of any of the articles below, please contact Bart Walker at 704-373-8923 or bwalker@mcguirewoods.com. Provider-Based Status “Hospitals and Health Systems: Provider-Based Status: The Rules and Common Issues” (co-authored with Elissa Moore), Health Care Law Monthly, April 2008 Establishing an ASC “Establishing an Ambulatory Surgery Center – A Primer [...]

A recently unsealed lawsuit in Illinois, which was joined by the State of Illinois, alleges that eleven different imaging centers in Illinois illegally gave monetary kick backs to physicians who were referring patients to their centers and also performing imaging procedures there. The allegations stem from the fact that the MRI or imaging centers would [...]